Dysphagia In Stroke Patients Research Articles

Fiberoptic nasopharyngoscopic evaluation of swallowing for the detection of dysphagia in patients with stroke: a integrative review

Difficulty for swallowing, clinically defined as dysphagia, is a common manifestation in stroke patients and significantly increases the risk of clinical complications. The objective of this study was to perform a integrative review of the literature regarding the accuracy of Fiberoptic Endoscopic Evaluation of Swallowing (FEES) for detecting dysphagia in patients with stroke. Methods: We conducted a search for articles published from 2000 to 2021 in the PubMed, Scopus, Embase, and Bireme databases. The following keywords were used: "fiberoptic endoscopic evaluation of swallowing (FEES)" and "stroke". Results: It was identified 23 articles that utilized fiberoptic endoscopic evaluation of swallowing (FEES) to screen stroke patients for dysphagia. The overall sensitivity and specificity of fiberoptic endoscopic evaluation of swallowing (FEES) ranged from 55.9% to 100%. Conclusions: The standardization of specific protocols for the diagnosis of dysphagia in stroke patients is necessary, both in clinical tests and fiberoptic endoscopic evaluation of swallowing (FEES), as special care is essential for these patients given their unique clinical characteristics.

Evidence for Intermittent Theta Burst Transcranial Magnetic Stimulation for Dysphagia after Stroke: A Systematic Review and Meta-analysis.

Dysphagia is the most common serious complication after stroke, with an incidence of about 37-78%, which seriously affects the independence of patients in daily life and clinical recovery. Repetitive transcranial magnetic stimulation (rTMS), as a non-invasive neuromodulation technique, is an emerging option for post-stroke dysphagia. Theta burst stimulation (TBS) is a new mode of transcranial magnetic stimulation that simulates the frequency of pulses released in the hippocampus.Intermittent theta burst stimulation (iTBS) has been shown to increase cortical excitability and improve swallowing function in patients. Our study sought to summarize existing clinical randomized controlled trials to provide evidence-based medical evidence for the clinical use of iTBS. A computer search was conducted on 4 Chinese (Chinese Biomedical Literature Database, VIP Information Resource System, CNKI, and Wanfang Medical Science) and 4 English (including Cochrane Library, Embase, PubMed, Web of Science) databases to retrieve all randomized controlled trials in Chinese and English that explored the effects of Intermittent Theta Burst Stimulation for post-stroke dysphagia. The retrieval years are from database construction to 23 November 2023. The primary outcome measure was a change in Penetration/Aspiration Scale (PAS), Standardized Swallowing Assessment (SSA) and Functional Oral Intake Scale (FOIS), Secondary outcomes included Fiberoptic Endoscopic Dysphagia Severity Scale (FEDSS), water-swallowing test (WST) etc. A meta-analysis by Standardized Mean Difference (SMD) and 95% confidence interval (CI) was performed with RevMan 5.3. we appraise risk of bias(RoB) of each study with the Cochrane RoB tool. Detailed instructions for using the Cochrane RoB tool are provided in the Cochrane Handbook for Systematic Reviews of Interventions (The Cochrane Handbook). Nine studies were obtained from eight databases after screening by inclusion and exclusion criteria, 567 patients from 9 studies were included in the meta-analysis, and one study was included in the qualitative analysis due to different control groups. Two of the nine studies had an unclear risk of bias, and four studies were at low risk. The results showed that iTBS significantly improved SSA, PAS, FOIS, and PAS scores in stroke patients compared to the control group(P < 0.05), and promoted swallowing function recovery. Our systematic review provides the first evidence of the efficacy of iTBS in improving dysphagia in stroke patients. However, the number of available studies limits the persuasiveness of the evidence and further validation by additional randomized controlled trials is needed.

The effectiveness of transcranial magnetic stimulation for dysphagia in stroke patients: an umbrella review of systematic reviews and meta-analyses.

Numerous studies have explored the use of repetitive Transcranial Magnetic Stimulation (rTMS) intervention in post-stroke dysphagia. The primary aim of this umbrella review was to appraise the methodological quality of systematic reviews (SRs), with and without meta-analyses (MAs), that synthesized the findings of randomized controlled trials (RCTs) exploring the effectiveness of rTMS in the management of dysphagia post-stroke. A secondary aim of was to evaluate the consistency and reliability of translational implications of rTMS for swallowing recovery after stroke across these SRs and MAs. We searched several databases from inception to the 14th of May 2023, to identify SRs and MAs that examined the effectiveness of rTMS in the management of dysphagia post-stroke. The methodological quality of the included studies was evaluated utilizing the AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews) instrument. To investigate the extent of literature overlap among the primary studies included in the SRs, the Graphical Overview of Evidence (GROOVE) was utilized. Of the 19 SRs that were identified, two studies received low quality ratings, while the rest (17) were rated with critically low quality based on the AMSTAR 2 rating. A high literature overlap across the SRs was observed. In all SRs and MAs reviewed, there was a consistent presence of at least some significant evidence supporting the effectiveness of rTMS in enhancing swallowing outcomes for individuals with dysphagia post-stroke, that is, all MAs reported at least a moderate overall effect in favor of rTMS (SMD range = [0.59, 6.23]). While rTMS shows promise for improving dysphagia post-stroke, the current evidence remains limited and inconclusive due to the methodological flaws observed in the published SRs and their respective MAs on the topic so far. Concerning the limitations of our study, language restrictions and methodological shortcomings may affect the generalizability of our findings.

Algorithms for the diagnosis and treatment of cognitive impairment and dysphagia in stroke patients

Stroke is a socially significant neurological disease, the second most common cause of disability and mortality. A wide range of neurological problems that occur after stroke: cognitive, motor, speech, and language disfunction, neuropsychiatric, swallowing disorders and others, complicate rehabilitation, impair social and everyday adaptation, and reduce the quality of life of patients and their caregivers. Cognitive impairment (CI) is one of the most significant and common complications of stroke. Stroke increases the risk of their development by 5-8 times. Dysphagia is also a common symptom of stroke, the cause of aspiration complications (pneumonia), and nutritional imbalance. It increases the possibility of developing CI and dementia, and contributes to an increase in mortality. Older adults with CI are at a higher risk of developing dysphagia, therefore the early symptoms of dysphagia (presbyphagia) should be diagnosed. In recent years, the connection between CI and dysphagia has been actively studied. It is extremely important to identify CI and swallowing disorders as early as possible in patients both before and at all stages after stroke; as well as to develop combined multidisciplinary protocols for the rehabilitation of patients with these disorders with pharmacological support for the process.

Use of sEMG for Swallowing Muscles Activity Quantification in Acute Phase of Stroke

Early diagnosis of dysphagia and aspiration risk is very important in minimizing the risk of various medical consequences. This study aimed to establish a scientific database for future sEMG-based dysphagia screening investigations by examining the electrical activity of swallowing muscles in acute stroke cases. A quantitative cross-sectional study was conducted on 61 stroke inpatients admitted to Dr. Hasan Sadikin General Hospital, Bandung, Indonesia, from July to November 2019. The objective of this study was to quantify electrical activities of the suprahyoid (SH) and infrahyoid (IH) muscles during swallowing. Patients participated in both dry swallowing and a 3 mL water swallowing task, with the sEMG used to measure electrical activity parameters (duration, swallowing initiation, time-to-peak, and amplitude) on both paretic and normal sides. The Wilcoxon test was used to compare the electrical activity parameters between the patients paretic and normal sides. Only amplitude showed a significant difference between the paretic and normal side (p=0.023) when performing the 3 mL water swallowing test. Other parameters did not exhibit significant differences in activity between muscle groups during both swallowing tests (p&gt;0.05), although varying water volumes led to distinct activities in both muscles. Despite the absence of a clear pattern in SH and IH contractions during swallowing, the result showed that the sEMG quantification method might become a promising method for screening dysphagia, complementary to FEES and VFSS. The non-invasive and cost-effective sEMG method can serve as an early screening tool for dysphagia in stroke patients. This study underscores the importance of further investigation on sEMG use, incorporating a larger sample size and diverse cohort results with various swallowing exercises (varying in volume and viscosity) to validate the use of sEMG in dysphagia screening.

Characteristics of post-stroke dysphagia: A retrospective study based on FEES.

This study aims to examine the characteristics of dysphagia in stroke patients with different lesion sites and explore the factors that impact the duration of nasogastric tube after post-stroke dysphagia (PSD). Patients with PSD were screened for analysis. Stroke types and lesion sites were confirmed using MRI or CT scans. Included patients were categorized into two groups: supratentorial stroke group (including lobar and deep intracerebral stroke subgroups) and infratentorial stroke group (including brainstem and cerebellar stroke subgroups). Fiberoptic endoscopic evaluation of swallowing (FEES), Penetration-aspiration scale (PAS), Yale pharyngeal residue (PR) severity rating scale, Functional oral intake scale (FOIS), Murray secretion severity rating scale (MSS), laryngopharyngeal sensation, and vocal fold mobility were investigated to assess the swallowing function. A total of 94 patients were included in the final analysis. Significant differences were found in PR scores (p<.001), PAS scores (p<.05), MSS scores (p<.05), and vocal fold mobility (p<.001) between infratentorial and supratentorial stroke groups. Moreover, lobar stroke showed significantly higher PR scores compared to the deep intracerebral stroke group (p<.05). Kaplan-Meier survival analysis indicated significant differences in the duration of nasogastric tube placement among the following groups: infratentorial versus supratentorial stroke, PAS ≤ 5versus PAS>5, PR ≥ 3versus PR<3, and normal vocal fold mobility versus vocal fold motion impairment group (p<.05). The infratentorial stroke may lead to worse swallowing function as compared to a supratentorial stroke. Additionally, patients with infratentorial stroke, PAS>5, PR ≥ 3, or vocal fold motion impairment may contribute to a longer duration of nasogastric tube placement.

Dysphagia Improvement Using Acupuncture Therapy: A Systematic Review

Background: Dysphagia is a common complication in patients with stroke. Although the research on acupuncture treatment of dysphagia has stepped up, the results are still inconsistent. In this review, we intend to answer the potential of acupuncture in treating dysphagia in stroke patients and which acupuncture points are the most promising for treating dysphagia. Methods: We used PRISMA (the preferred reporting items for systematic reviews and meta-analysis) 2020 guidelines in conducting this review. A literature search was performed in four databases (PubMed, ScienceDirect, Cochrane, and Willey online library) to find eligible randomized controlled studies that assessed the effect of acupuncture in post-stroke dysphagia. The search time is from 2010 to 2022. Study quality was assessed using the critical appraisal skills program (CASP), and the risk of bias was evaluated by the RoB software, version 2 (risk-of-bias tool). The data were analyzed thematically. Results: A systematic electronic search identified 1409 publications through forward and backward searching of relevant papers. The full-text screening was conducted on 777 articles. A total of 681 articles failed to meet eligibility criteria at this stage, and only 6 articles were finally eligible for further analysis. The results showed that compared with rehabilitation, acupuncture significantly improved dysphagia in post-stroke patients. Gallbladder (GB) 20 is often used as an acupoint. In addition, the frequency and duration of treatment also contributed to a more significant increase in dysphagia improvement. Conclusion: Acupuncture could effectively improve dysphagia in post-stroke patients, and acupuncture combined with rehabilitation has a better effect.

Effectiveness of Nursing Intervention Based on the International Classification of Functioning, Disability, and Health for Improving Dysphagia in Stroke Patients

Effectiveness of Nursing Intervention Based on the International Classification of Functioning, Disability, and Health for Improving Dysphagia in Stroke Patients

Destruction of Vowel Space Area in Patients with Dysphagia after Stroke.

Dysphagia is associated with dysarthria in stroke patients. Vowel space decreases in stroke patients with dysarthria; destruction of the vowel space is often observed. We determined the correlation of destruction of acoustic vowel space with dysphagia in stroke patients. Seventy-four individuals with dysphagia and dysarthria who had experienced stroke were enrolled. For /a/, /ae/, /i/, and /u/ vowels, we determined formant parameter (it reflects vocal tract resonance frequency as a two-dimensional coordinate point), formant centralization ratio (FCR), and quadrilateral vowel space area (VSA). Swallowing function was assessed using the videofluoroscopic dysphagia scale (VDS) during videofluoroscopic swallowing studies. Pearson’s correlation and linear regression were used to determine the correlation between VSA, FCR, and VDS. Subgroups were created based on VSA; vowel space destruction groups were compared using ANOVA and Scheffe’s test. VSA and FCR were negatively and positively correlated with VDS, respectively. Groups were separated based on mean and standard deviation of VSA. One-way ANOVA revealed significant differences in VDS, FCR, and age between the VSA groups and no significant differences in VDS between mild and moderate VSA reduction and vowel space destruction groups. VSA and FCR values correlated with swallowing function. Vowel space destruction has characteristics similar to VSA reduction at a moderate-to-severe degree and has utility as an indicator of dysphagia severity.

Effects of Comprehensive Swallowing Intervention on Obstructive Sleep Apnea and Dysphagia After Stroke: A Randomized Controlled Trial

ObjectiveThis study aims to explore the effects of comprehensive swallowing intervention on obstructive sleep apnea (OSA) and dysphagia in stroke patients. MethodsWe performed a randomized controlled trial in stroke patients with obstructive sleep apnea (OSA) complicated by dysphagia, divided into treatment group and control group. The treatment group underwent comprehensive swallowing intervention and received swallowing care for 4 weeks, while the control group received only swallowing care. Outcome measurements were obtained at baseline and after the 4-week intervention, evaluated by polysomnography (PSG), videoendoscopic swallowing study (VFSS) synchronized surface electromyography (sEMG), oropharyngeal magnetic resonance imaging (MRI) and swallowing assessment scales. ResultsSixty patients with stroke (30 treatment and 30 control) were eligible to participate in this study. There were no significant differences in any assessment between two groups at baseline. After a 4-week intervention, compared with to control group, there was a significant decrease in the apnea-hypopnea index (AHI) and oxygen desaturation index (ODI), and increased mean and minimal oxygen saturation (SaO2), amplitudes of suprahyoid muscle group (ASUPMG) and subhyoid muscle group (ASUBMG). Moreover, the posterior palatal distance (PPD), posterior lingual distance (PLD) and minimal cross-sectional area (MCSA) were obviously elevated in the treatment group. Additionally, the scores of Gugging swallowing screen (GUSS) and VFSS were significantly increased in the treatment group, compared to control group. ConclusionsThe comprehensive swallowing intervention had therapeutic effects on OSA and dysphagia after stroke, and the mechanism was related to enhancing oropharyngeal muscle strength and changing upper airway structure.

A Study to Compare the Efficacy of palatal Electrical Stimulation with Non-Swallowing Exercises vs Palatal Electrical Stimulation with Swallowing Exercises in Patients with Dysphagia Following Acute Stroke

Aim and objective: Stroke is one of the leading causes of mortality worldwide and in India the prevalence of stroke among younger individuals is high compared with other countries, Dysphagia occurs commonly in ischaemic stroke as well as haemorrhagic stroke and this study which reveals the importance of physiotherapeutic interventions in treating dysphagia in stroke patients. The study is to compare the effects of palatal electrical stimulation with Non swallowing exercises VS Palatal electrical stimulation with swallowing exercises in patients with dysphagia following acute stroke. Methodology: 20 stroke patients (13 males and 7 females) between the age group of 30 to 70 years with post stroke dysphagia were recruited with GUSS score between 4 to 7. 20 subjects were randomly divided into two groups. Group A divided into 10 subjects who received palatal electrical stimulation with swallowing exercises. Group B divided into 10 subjects who received palatal electrical stimulation with Non- swallowing exercises. Study design: This study design is based on Comparative study design and carried out in Hospitals around Chennai and home care patients. The Guggling swallowing Scale and Dysphagia Severity Rating Scale were studied for 2 weeks and 5 sessions per week was done. The included criteria is Acute stroke patients with swallowing difficulty, Age between 30 to 70 years, Medically stable patients and Patients on Ryle’s tube. The Exclusion criteria is Stroke patients with cognitive impairment, Brainstem stroke, Patients with tracheostomy, Stroke more than 6 months duration and Patients with pulmonary complications Results: The patients were screened initially with GUSS scale. The pre- test mean values for experimental and control group are found to be 5.50 and 6.10 respectively. The post- test mean values for experimental and control group are found to be 13.40 and 10.10 respectively. There is significant effect of treatment group A (Control Group) in decreasing the value of DSRS (t = 9.00, p = 0.000 &lt; 0.05). In addition, the mean value of DSRS has decreased from 8.50 to 5.80, which confirms that Control Group (A) is significantly effective in decreasing the value of DSRS score. Conclusion: The results of this study suggest that stroke patients with dysphagia benefit from palatal electrical stimulation and exercises. But combined method of palatal electrical stimulation and Non-swallowing exercises proved to be more superior and effective treatment for the acute stroke patients with dysphagia than treating with combined method of palatal electrical stimulation and swallowing exercises. Keywords: Dysphagia, Stroke, GUSS, DSRS.Dysphagia, Stroke, GUSS, DSRS.

Acupuncture Reduces the Risk of Dysphagia in Stroke Patients: A Propensity Score-Matched Cohort Study.

Background: Post-stroke dysphagia (PSD) affects the quality of life in stroke patients, impairs their rehabilitation ability, and causes other complications following stroke. Currently, there is currently some understanding of PSD risk factors, but its protective factors remain largely unknown.Objective: To analyze the effects of acupuncture (AP) on dysphagia in stroke patients and explore its potential as a preventive therapy.Methods: Patients with a diagnosis of stroke from 2010 to 2019 were selected and followed until 2020, utilizing factors such as age, gender, stroke location, stroke type, and baseline comorbidity. To compare the incidence of dysphagia, equal numbers of stroke patients treated with and without AP (n = 1,809) were matched by 1:1 propensity scoring. The Cox proportional hazards model and Kaplan-Meier method were used to assess the risk of dysphagia as an outcome measure.Results: The stroke patients treated with AP had a lower risk of dysphagia after adjusting for age, gender, stroke location, stroke type, and baseline comorbidity [adjusted hazard ratio (AHR) = 0.43, 95% confidence interval = 0.37–0.49] compared with those in the non-AP cohort. AP also decreased the risk of PSD among different gender groups. The risk ratios were AHR = 0.45 and AHR = 0.33 for males and females, respectively. AP also reduced the risk for PSD among different age groups. The risk ratios were AHR = 0.20, AHR = 0.37, AHR = 0.41, and AHR = 0.45 for the 18–39, 40–59, 60–79, and >80 years-old groups. Regarding stroke types (ischemic, hemorrhagic, and mixed type), patients treated with AP had a lower risk (AHR = 0.47, 0.28 and 0.17, respectively). With respect to stroke location, the risk of PSD in AP-treated patients was decreased regardless of location: brain stem (AHR = 0.41), diencephalon (AHR = 0.13), or multiple lesions (AHR = 0.40), the risk of PSD in AP-treated patients was decreased. For all baseline comorbidities, AP attenuated the risk of dysphagia. The cumulative incidence of dysphagia was remarkably lower in the AP group than in the non-AP group (log-rank test, P = 0.000).Limitations: First, this was a single-center clinical retrospective study. Second, we did not classify the severity of stroke and dysphagia. Third, all data were extracted manually. Lastly, the sample size was relatively small. Thus, future studies with larger sample sizes are warranted to verify our findings.Conclusion: Acupuncture treatment attenuates the risk of dysphagia in stroke patients. Future research should increase the sample size and elaborate further on the details of the AP protocol.

Decreased Maximal Tongue Protrusion Length May Predict the Presence of Dysphagia in Stroke Patients

ObjectiveTo investigate the relationship between maximal tongue protrusion length (MTPL) and dysphagia in post-stroke patients.MethodsFree tongue length (FTL) was measured using the quick tongue-tie assessment tool and MTPL was measured using a transparent plastic ruler in 47 post-stroke patients. The MTPL-to-FTL (RMF) ratio was calculated. Swallowing function in all patients was evaluated via videofluoroscopic swallowing study (VFSS), PenetrationAspiration Scale (PAS), Functional Oral Intake Scale (FOIS), and Videofluoroscopic Dysphagia Scale (VDS).ResultsThe MTPL and RMF values were significantly higher in the non-aspirator group than in the aspirator group (MTPL, p=0.0049; RMF, p<0.001). MTPL and RMF showed significant correlations with PAS, FOIS and VDS scores. The cut-off value in RMF for the prediction of aspiration was 1.56, with a sensitivity of 84% and a specificity of 86%.ConclusionThere is a relationship between MTPL and dysphagia in post-stroke patients. MTPL and RMF can be useful for detecting aspiration in post-stroke patients.

The Preventive Effect of Dysphagia Screening on Pneumonia in Acute Stroke Patients: A Systematic Review and Meta-Analysis.

(1) Background: Dysphagia is common in acute stroke patients and is a major risk factor for aspiration pneumonia. We investigated whether the early detection of dysphagia in stroke patients through screening could prevent the development of pneumonia and reduce mortality; (2) Methods: We searched the PubMed, Embase, Cochrane Library, and Scopus databases for relevant studies published up to November 2021. We included studies that performed dysphagia screening in acute stroke patients and evaluated whether it could prevent pneumonia and reduce mortality rates. The methodological quality of individual studies was evaluated using the Risk Of Bias In Non-randomized Studies of Interventions tool, and publication bias was evaluated by the funnel plot and Egger’s test; (3) Results: Of the 6593 identified studies, six studies met the inclusion criteria for analysis. The screening group had a significantly lower incidence of pneumonia than the nonscreening group did (odds ratio (OR), 0.60; 95% confidence interval (CI), 0.42 to 0.84; p = 0.003; I2, 66%). There was no significant difference in mortality rate between the two groups (OR, 0.61; 95% CI, 0.33 to 1.13; p = 0.11; I2, 93%); (4) Conclusions: Early screening for dysphagia in acute stroke patients can prevent the development of pneumonia.

Nursing of Dysphagia in Stroke Patients

Nursing of Dysphagia in Stroke Patients

Voxel-based lesion symptom mapping analysis for dysphagia in stroke patients with isolated cerebellar lesions.

Because the cerebellum plays a role in motor coordination, timing, sequencing, and feedback, it is hypothesized to be involved in swallowing-related functions. The role of the cerebellum in deglutition has become increasing evident, but the exact nature of this role remains inconclusive because of limited data from pure cerebellar lesions. Therefore, we conducted location analysis in isolated cerebellar lesions to complement previous findings and provide additional information. We reviewed 40 stroke patients with isolated cerebellar lesion. Lesion location and volume were measured on brain magnetic resonance images. We generated statistical maps of lesions related to VDS using voxel-based lesion symptom mapping (VLSM). We also created an overlay map of subgroups according to VDS score, those who have low risk and those who have high risk. Patients with cerebellar lesion had difficulty swallowing, both in the oral and pharyngeal phases. Multivariate analysis of cognitive function was selected as an independent predictor. In the group of high-risk patients, the overlay map showed some bilateral asymmetry, with a wider distribution in the left hemisphere and involvement of deep cerebellar nuclei. Using VLSM, we found that lesion location was associated with dysphagia. Although these results were not statistically significant, they showed a lesion pattern with predominant distribution in the left posterior lobe. Our results suggest that damage to the posterior lobe of the left cerebellum tends be related to severity of dysphagia in patients with isolated cerebellar lesion.

Best Practice Recommendations for Dysphagia Management in Stroke Patients: A Consensus from a Portuguese Expert Panel

Dysphagia is frequent after stroke, and it increases the risk of respiratory infection, dehydration and malnutrition, resulting in worse outcomes. Different clinical guidelines present recommendations for the assessment and management of dysphagia in stroke patients in a scattered way. These best practice recommendations address seven clinical questions on the assessment and management of dysphagia in stroke patients, gathering the best-updated evidence. A systematic literature review using the PICO strategy was performed. The recommendations draft was then appraised by a multidisciplinary panel of experts (nutritionists, physiatrists, speech-language pathologists and rehabilitation nurses) in a total of 3 Delphi rounds. A minimum of 80% consensus was established, and the final version offers a total of 21 recommendations for use in clinical practice for stroke patients. These clinical recommendations are an overview of the most recent evidence combined with experts’ consensus and translated into clinically relevant statements. In implementing recommendations at the local level, health professionals should identify facilitators and barriers to evidence-based practice within their contexts and determine the best strategies to address local needs. Where the change is needed, initial and continuing training on all recommendations is essential and relevant.

Transcranial direct current stimulation (tDCS): its effect on improving dysphagia in stroke patients

BackgroundTranscranial direct current stimulation (tDCS) may have a potential for improving post-stroke dysphagia.ObjectiveThe purpose of this study was to examine the effect of tDCS on improving dysphagia in stroke patients.Patients and methodsForty stroke patients were divided randomly into two equal groups (the study (group A) and control groups (group B). Group A received a physical therapy program and active (tDCS), and group B received the same physical therapy program and sham (tDCS). The Dysphagia Outcome and Severity Scale (DOSS) and videofluoroscopy were performed in all patients before and after 2 weeks of the treatment program.ResultsBefore treatment, there were no significant differences between the two groups for DOSS score or digital fluoroscopic findings. After treatment, there were significant differences between the study and control group for DOSS score and digital fluoroscopic findings.ConclusionAnodal tDCS is effective in improving dysphagia in stroke patients.

Diagnostic Accuracy of a Bedside Screening Tool for Dysphagia (BSTD) in Acute Stroke Patients

Background and purposean estimated 40-80% of acute ischemic stroke patients have dysphagia and about 14% develop stroke-associated pneumonia. However, it may be difficult to detect swallowing problems at admission. Moreover, there might not be an on-duty specialist skilled in the diagnosis of this condition. This study aimed at developing a user-friendly bedside examination to identify the risk of dysphagia in stroke patients at hospital admission. Methodsa diagnostic accuracy study was carried out to assess the concurrent validity of a simple Bedside Screening Tool for Dysphagia (BSTD) in acute stroke. All the consecutive stroke patients admitted between January and April 2018 were enrolled. Sensitivity, specificity, positive (PPV), negative predictive values (NPV) and the Cohen K concordance index scores, reported by nurses and speech-pathologists, were assessed. Resultsa total of 67/120 patients (55.8%) were male; overall average age was 67.4 (range 45-91) and 80.8% of the whole population had a history of ischemic stroke. The nursing staff identified 33.3% of dysphagia cases at admission and the speech pathologists 30%. The Cohen K was 0.92 (optimal concordance when K was > 0.8), sensitivity was 100%, specificity 95.2%, PPV 90% and NPV 100%. Conclusionsour BSTD had a 100% negative predictive value, indicating that this screening test is very useful in ruling out/confirming dysphagia in acute stroke patients

Translation and Validation of the TOR-BSST© into Brazilian Portuguese for Adults with Stroke.

Brazil has a higher rate of dysphagia in stroke patients compared to developed countries, but does not have a fully validated method for early identification of dysphagia in this population. The aim of this study is to translate the TOR-BSST© into Brazilian Portuguese and assess the newly translated version for reliability and validity with Brazilian adult patients with stroke. The translation of the TOR-BSST© followed a multi-step process, according to the International Quality of Life Assessment project. For validation, we included patients with age ≥ 18years and stroke diagnosis confirmed by neuroimaging and tolerance for videofluoroscopic swallowing assessment. The BR-PTfinal TOR-BSST© was administered by two trained screeners within two hours of videofluoroscopy. All assessors were independent and blinded. Estimates for reliability used the intraclass correlation coefficient (ICC) and for accuracy both sensitivity (SN) and negative predictive (NP) values were used, along with 95% confidence intervals (CI). Sixty patients were enrolled and tested for a mean (SD) of 14.4 (6.9) days from last seen normal. Of all the patients, 41 (68.3%) failed the BR-PTfinal TOR-BSST© and 21 (35%) were scored to have dysphagia on videofluoroscopy, of which 11 (52.4%) had mild dysphagia. The overall reliability between screeners was satisfactory (ICC = 0.59; 95% CI 0.32 to 0.76). The SN and NP values for the BR-PTfinal TOR-BSST© were 85.7% (95% CI 0.62-0.96) and 84.2% (95% CI 0.72-0.95), respectively. The TOR-BSST© was successfully translated to Brazilian Portuguese with the BR-PTfinal TOR-BSST© proven to have high sensitivity and negative predictive values when compared to gold standard videofluoroscopy.